Clinical Features of Adult Patients with Acute Hepatitis B Virus Infection Progressing to Chronic Infection

Abstract

Background. Information regarding the progression of acute hepatitis B virus (HBV) infection to chronic infection in adults is scarce. Methods. Twenty-five adult patients with acute HBV infection (14 men and 11 women, 18–84 years old), whose clinical features progressed to those of chronic infection (group A) or did not (group B), were studied retrospectively. Results. There were 3 and 22 patients in groups A and B, respectively. Two of the 3 patients of group A lacked the typical symptoms of acute hepatitis. No differences were found between groups with respect to age, sex, or HBV genotypes. However, total bilirubin and alanine aminotransaminase levels were significantly lower in group A. Conclusions. Three of the 25 adult patients with acute HBV infection progressed to chronic infection. Hepatitis was mild in these patients. Patients with mild acute hepatitis B or unapparent HBV infection may have a higher risk of progressing to chronic infection.

Is mother-to-infant transmission the most important factor for persistent HBV infection?

“… 64 In adults, acute clinical hepatitis B seems to be a self-limiting disease that rarely leads to the development of the carrier state. 65 , 66 In our previous study in Shanghai, mainland China, 8.5% of adult patients with acute hepatitis B developed a chronic carrier state; subgenotype C2 HBV was proven to be a unique independent risk factor (OR = 6.97) for chronic progression. 67 Table 3 summarizes the chronic progression of HBV infection acquired from birth to adulthood based on published studies.…”

“…Unsafe infections, close contact with HBeAg-positive mothers and other family members with HBV infection, and close contact with children carrying HBV might be the major causes of the chronic progression of HBV infection acquired in early childhood or in adulthood. 62 , 63 , 64 , 65 , 66 , 67 Currently, the young generation of Chinese born after 1992 in mainland China has a very low prevalence of HBsAg. 1 This achievement is not completely attributable to the widespread application of HBV vaccination because the prevalence of anti-HBc antibody is also very lower in this population.…”

Incidence and Influencing Factors of New Hepatitis B Infections and Spontaneous Clearance: A Large-Scale, Community-Based Study in China

“…Previous studies proposed that both viral and host factors were determinants of seroclearance; however, this proposal has still not been completely elucidated ( 4 ). Infants were believed to have 80–90% chronicity ( 7 , 43 – 46 ), and 23–46% of children ≤ 6 years old were chronic carriers of HBsAg in a Taiwanese/Chinese population ( 47 – 49 ).…”

“…After infection with HBV, 1–2% of cases evolve into fulminant hepatic failure, and 5–10% of adult cases evolve into chronic infection ( 1 ). In addition, others typically have no symptoms and progress to spontaneous clearance of HBV within ~3 months ( 4 – 6 ). Since its discovery in the 1960s, hepatitis B surface antigen (HBsAg, also commonly known as Australia antigen) has become an important serological marker for screening for HBV infection ( 7 ).…”

Table_1.DOC

“…After infection with HBV, 1-2% of cases evolve into fulminant hepatic failure, and 5-10% of adult cases evolve into chronic infection (1). In addition, others typically have no symptoms and progress to spontaneous clearance of HBV within ∼3 months (4)(5)(6). Since its discovery in the 1960s, hepatitis B surface antigen (HBsAg, also commonly known as Australia antigen) has become an important serological marker for screening for HBV infection (7).…”